Provider Demographics
NPI:1255454799
Name:HARRISON, PAUL JAMES (MS)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:JAMES
Last Name:HARRISON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11899 E PONCE DE LEON
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-8672
Mailing Address - Country:US
Mailing Address - Phone:520-749-1619
Mailing Address - Fax:520-749-1636
Practice Address - Street 1:350 W SAHUARITA RD
Practice Address - Street 2:
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85629-9000
Practice Address - Country:US
Practice Address - Phone:520-625-3502
Practice Address - Fax:520-299-1870
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ584054Medicaid